Background Rheumatological disease induced shoulder pain could affect most of the ADLs and work requiring shoulder height and upper arm rotation such as combing hair, pulling pants up, and reaching for something in a cabinet. Pain affects the stability of hands making difficulties in using chopsticks and make-up. Pain also affects sleep quality and psychological factors such as stress and depression. Methods Occupational therapy (OT) aimed to alleviate pain, prevent further deterioration, promote independence in ADL, work, and leisure by means of fascia therapy, mobilization and strengthening; training on proper body mechanics; fabricating splinting to enhance structural support; prescription of aids and gadgets; and self-management strategies. Results During flare up, OT educate patient to minimize stress on shoulder joint, such as inflammatory self-management and gentle stretch of surrounding muscles, mobilization, and proper body mechanics in ADLs. Aggressive stretching should be avoided. Specific joint protection techniques to avoid extra stress on shoulder during their ADL and work includes proper head and neck position with supporting devices; avoid side lying on the painful side when sleeping etc. In addition, avoid over generalization of basic joint protection techniques, e.g., carrying heavy bags on forearm may increase loading to the shoulder; while using small wheeled-trolley to carry heavy things in damping road may cause impact to shoulder. Instead, using small towel to minimize rotational force on shoulder; and use upper body part to push heavy door in shopping centre to minimize the impact loading on shoulder joint, etc. On the other hand, training on basic relaxation techniques like breathing focus or progressive muscle relaxation could allow relieve pain. For muscle strengthening, muscle balance must be the basic consideration by means of pendulum exercise, and progress to isometric and eccentric training. Strengthen core and upper back muscles should be included to provide basic stability. Conclusion Patient with severe shoulder instability but not fit to receive surgery, could result in pain and functional deficit. Thus, patient is encouraged to compile on different bracing, e.g., AC joint brace or shoulder sling for certain period to optimize joint stability and pain. Alternative ADL and work strategies e.g., lowering the working area or using safety ladder; and utilizing some aids e.g., long-handle reacher, and electrical screw driver, could promote their independence. Advanced technology could also be employed like exo-skeleton device promote patient’s function independence ADLs and work independence.
Read full abstract